Building a Diverse Midwifery Workforce in the United States to Improve Maternity Care Outcomes

Frontier Nursing University, a leading educator in graduate nursing and midwifery, strives to bring greater awareness to the important role of nurse-midwives and provide resources for others who may be thinking about a career in nurse-midwifery. We advocate for integrating midwifery into the health care system to improve access to care, as nurse-midwives play an integral role in maternity and primary care for women and families.

Maternal Crisis in the U.S.

The United States has experienced increasing maternal mortality rates over the last 25 years. In fact, each year about 700 women die of pregnancy-related causes and more than 50,000 suffer severe complications but do survive.

When we compare the U.S. to other industrialized nations, their maternal mortality rates are decreasing, while the U.S. rate continues to rise.

Racial disparities are evident; the risk of pregnancy related deaths for black women is three to four times higher that those of white women.

Maternal Mortality Preventable Causes

More evidence is needed to understand the actual causes of these deaths; research suggests that more than half of these deaths are preventable. There are some identified factors that contribute to the problem. We know that in the U.S., excellent care is available for some populations, but not all. We have a shortage of providers and facilities, as well as financial, bureaucratic and transportation issues. Language barriers and a lack of consistent, culturally-appropriate care is a contributing factor.

Medical issues such as cardiovascular conditions, pregnancy-related hypertensive disorders, hemorrhage and hypertension are among the highest risk factors for poor birth outcomes.

Nearly half of women are obese prior to becoming pregnant, and half of women gain more than the recommended amount of weight during pregnancy. One in five women smokes within three months of getting pregnant, while one in ten women smokes during the last three months of their pregnancy. About one in nine women has symptoms of major depression or other mental health disorders.

Each of these health factors contributes to the high rate of maternal complications we are seeing in the U.S. Many states, including Kentucky, either have or are creating maternal mortality review committees to analyze every death so that we can better understand the causes and contributing factors. This will allow the creation of programs designed to address the specific problems.

With a rising number of births expected in our country, the shortage of maternity workforce is concerning. Forty percent of U.S. counties do not have a midwife or obstetrician. The problem is exacerbated among rural populations, as we are seeing more hospital closures or the discontinuation of maternity care at hospitals that do remain open.

The Need for a Diversified Maternity Workforce

With the above statistics in mind, it is more important than ever to develop and begin working toward attainable solutions.

Midwifery care has been proven to contribute to improved health outcomes for mothers during pregnancy, birth and postpartum. A diverse, culturally-sensitive, respectful midwifery workforce will increase access to quality care and improve maternal health outcomes around the U.S.

Frontier Nursing University is working to increase the number of certified nurse-midwives who can provide quality maternity care in rural and underserved areas. What’s more, Frontier also aims to increase the racial and cultural diversity among those care providers in order to offer women and families care that makes them the most comfortable and therefore more likely to access services.

Our distance education model offers community-based education for nurse-midwives where they live and work. The American Midwifery Certification Board reported 11,850 certified nurse-midwives in the U.S in 2017.

Despite a growing number of midwives, many rural areas still have women left unserved or underserved. Around 40 percent of counties in the U.S. do not have a practicing midwife or obstetrician. In 2015, the American College of Nurse-Midwives reported 121 practicing nurse-midwives in the state of Kentucky. These midwives only attended 5.95 percent of all births in the state of Kentucky (source).

Because the number of births per year is growing (projected to be more than 4.4 million by 2050), we need to dramatically increase the number of nurse-midwives providing care in the U.S. in order to meet the health care needs of women and families.

As an educational institution with a strong community of educators and graduates who are nursing and midwifery care providers, Frontier focuses strongly on primary and preventative care and collaborative health care environments. We strive to develop graduate nursing and midwifery education programs to address the factors that lead to maternal mortality and poor health outcomes. Finally, we must diversify the health provider workforce so that patients are more likely and willing to participate in care.

Frontier Nursing University is the birthplace of nurse-midwifery and family nursing in America. FNU recently held its fourth annual virtual event in recognition of National Midwifery Week, Sept. 30-Oct. 6.